Childhood cancer survival in Africa, Asia, Latin America and the Caribbean, during 2008-2017 (SURVCAN-3): a population-based benchmarking study of 16 821 children.
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BACKGROUND: Accurate information on childhood cancer survival is essential for improving health systems. Survival is believed to be low in low-resource countries, but population-based survival estimates are scant. We aim to provide reliable and comparable survival estimates in these settings. METHODS: We included 16 821 patients from 47 population-based cancer registries in 23 countries in Africa, Latin America and the Caribbean, and Asia. We used the Cancer Survival in Countries in Transition project data (children aged younger than 15 years, diagnosed 2008-2012, followed until 2014) and data from Rwanda (2013-2017, followed until 2022). We estimated 1-year, 3-year, and 5-year observed survival using the Kaplan-Meier method, by diagnostic group, country, region, Human Development Index, income, and sex. RESULTS: Survival was higher in registries included from the Caribbean (namely, Puerto Rico [United States], Martinique [France]) and Central America (Costa Rica), Asia, and the Middle East and North Africa compared with those included from South America and sub-Saharan Africa. Survival correlated with the Human Development Index. For leukemia, 3-year survival varied from 30.4% (95% confidence interval [CI] = 12.4% to 50.6%) in Kenya to 89.5% (95% CI = 83.8% to 93.2%) in Puerto Rico; for central nervous system tumors from 32.0% (95% CI = 13.9% to 51.8%) in Algeria to 79.3% (95% CI = 69.1% to 86.5%) in Puerto Rico. The findings should be interpreted with care, as registry coverage varies and may not reflect national and regional survival. CONCLUSION: The variability of the population-based survival estimates across predominantly low- and middle-income countries highlights gaps in cancer registration, access to care, and quality of care. This study provides benchmark data for the World Health Organization Global Initiative for Childhood Cancer generated by population-based cancer registries, which should be supported in all countries.